Surprise medical bill ban heads to Gov. Brown

Measure would take effect March 2018

Oregon lawmakers gave their final approval Tuesday to a bill that prohibits surprise medical bills from out-of-network providers. The measure now goes to Gov. Kate Brown, who is expected to sign it.

House Bill 2339 prohibits out-of-network medical providers from billing patients for more than their in-network rates for services provided at in-network facilities. The most common example of this is a hospital emergency room, where patients might unintentionally receive care from out-of-network physicians, even if the hospital is in their insurer’s provider network.

The measure requires insurers to reimburse out-of-network providers at a rate that is yet to be determined.

“The status quo where consumers who sometimes do everything they could reasonably be expected to avoid being on the hook for out-of-network charges and still sometimes get these giant surprise bills, it’s just unjust and unacceptable,” said Jesse Ellis O’Brien, policy director for the consumer advocacy group OSPIRG. “With the passage of this bill, we’re taking a big step in the right direction.”

The main point of contention while the bill was debated concerned how much out-of-network providers would be paid for their services. If it wasn’t high enough, physician groups argued doctors might leave the state to practice elsewhere. Insurers, on the other hand, argued if it was too high, there would be no incentive for doctors to form contracts with them.

The Senate amended the bill to say the state Department of Consumer and Business Services, which regulates commercial insurance in Oregon, will convene a work group to determine fair rates. That fix changed some minds among House lawmakers, 11 more of whom voted yes the second time around when they voted 47 to 10 to approve the final version with the Senate’s changes Tuesday. The Senate approved the measure last week on a 25-to-5 vote.

Rep. Knute Buehler, a Republican from Bend, was among those swayed by the promise of allowing state regulators to determine a fair reimbursement rate at a later point. An earlier version of the bill, which he voted against, would have reimbursed out-of-network emergency room providers at 175 percent of Medicare rates, which Buehler said is less than they’re reimbursed as in-network providers.

“That creates no incentive for insurers to negotiate with those out-of-network providers to bring them into the network,” Buehler said. “That made no sense to me.”

If signed, the law would take effect in March, which O’Brien said is unfortunate, as his organization would have preferred it take effect immediately.

Until then, Buehler, an orthopedic surgeon with The Center Orthopedic & Neurosurgical Care & Research in Bend, said it’s important that patients in emergency situations ask whether the providers who treat them are in their insurance networks. If that’s not possible, loved ones with them should ask, he said. If the providers are not in network, he urges people to ask how much they will be charged for a specific service.

“There are bad actors, actually: providers who are taking advantage of the situation, and that needs to stop,” Buehler said. “One way that can stop is by empowering the consumer, the patient in the situation.”